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NO, 21-80 .105
PETITION FOR LETTERS OF ADMINISTRATION
IN Tille gSTA'1'I'; OJl ..1.I>~l.......?.:......I!.;:',<;.!(......,.................. DECEASED,
To ,."..,(!J1.I!JI...,"',Q,;"',..,~:,{,~.I.,F"",,"",..,"""""""..""",.."....""",.,""
Register uf Wills fIll' the Couut)' of Cumberland, iu the ConllllOllwealth of I'ellu"yil'ania,
The Petitioll of ..c..?I.!.I?/..f...,..,/f?..., ,..f../!tf.!i'.l!.,?,,?i::,~?,1........,........ ...., ......,......,' ....,
"..",:1:/:1.11"1....",.",..,, ..",.....,...."" respectfully showet h that ",(J, ,/!..I.. ,.. ,1""" ,1?C.r;"0~..",, "'.'",, ,.."""..",
'd t fS- v7/1 /I1/'n.llLE 7"0 tv Township (' \ '1 I C' t, St,t t' p. s'l
was a res I en 0 .....................,,,.fl.ft......-:..................."l#H'GH-gh "um lCl all( DUn),...\ e 0 enn..).
vania. and a Citizen of United Stutes. and departed this life intestate in the County of f!.Y.(!l,,(J.[1:::.,
...LAlX,()",.."".,....."" and State of ,.I.~?"I.!/~~:(L.,iI..~,!-!./.h"."".."""",., ,."" ..'"..',..".., "",.."""..". ..",..,.."..
on ,El!.!.P..{!.'I................., the ..1..3...1..11.,........,..,..,.... day of ..J.:..v..(Y,;;"........,..........,..,.... A, D.. 19,f,.O,..,
at the age of .7,~...... years,
That the said ....(;,!!..t....f"..,..eg,r.:::,0...................,......,....,.. tleceased, left surviving the following
named widow or -husband, heirs and next to kin. to wit:
Name
Relatiollship
Residence
................................................................
............................................
.[~/J..,..~,1..~/!./!.,V.,?'...,...,..,..,',..".,..,..
,!l.I!(:f.({(,{, tlJ!..f?,c' ..<7/!IJ.... ./,7..1.9..2
C.l::lr,(?, (~:. ."(1,, ,l.!i/l t.f:I,?!,I,,?!.A
,..,. (d., (J!~..r;ll..! At., ..,.."
................................................................
............................................
................................................................
................................................................
............................................
19.""(lil:!.P.!::/,...l/..'?:9./?.....,...,.,,..
!,..E'(.,(.11q"~':J!.,,",I?I.l.,,,f}'!..r.:..;.
1t/!1.~, f:!?".. ..Q.:,....!..{~ .&, ......,..',..
,.. s.. '!,!.:,.,..,..",." ,..,..',...,....
................................................................
............................................
................................................................
................................................................
............................................
JIJ.:;J..J.
...'!?..........................................................
f'Ii,~.r...,W.(/,!.t..f.!.'?1.,{?Jj?I!.,:....!] ,;,)./
!3LTTY;:>' //I,'hll"J/V
.....................................l.~.......................
i?/!.,~..~/i.g>1..,',.",.,.."
................................................................
...........................................,
................................................................
That those above named include all of the next of kin. so far as known,
The said decedent was possessp.d of personal property to the estimated value of $..'!.,~..'!,~,U~,~,r.t!?
and of Real Estate, less incumbrance, to the estimated value of $....l'!..~,(:(.,?..,..,......, as near as can be
ascertained.
........................................................................................................................................................................................
That the said Real Estate in so far as is known is located in ,....,..,..,..................,,,...............,...............
Therefore, your petitioner(s) respectfully apply(ies) for Letters of Administration in the above
named estate,
Dated ../'!..,....l..C!...f!.,.f.........,..,..,.., A, u.. l!),R,Q.,
Signature and Addres"
of Petitioner(,,)
,./~4~,,71.2,,:,04i~1~~~,.,
..!.. a...'.h.... "v..T..t!./1.... jl. .Y.:f.t!., k, [:;,.... ..,...." "..' ..""
../:I/!.Ii'/!:.,(y!.,~"'!L.;,,,,I.&...:....J.?!.??,..,..,",,...,
.............,..........................................................................
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND t ss:
,..,(y:..(!.t.~""I1..",!.!i/!~h.,'<"I./::,'-:,(;,!.?,"""""""'"..'""""".. ", ","',' ",,,,..,,:,,,,,,,,,,,,,,,.. ,'," ,"',"'" named
in the above application being duly ,..,S..~..~,1.!Y.,,,..,....,,,............ according to law, say that the facts set
forth in the above application are true to the best of ,JffJ<:.,,,, knowledge and belief.
,,,J..t!~:..~,1.,fY...,,..,",..,,",,....,,..,,,..,.... and subscribed I
I
~~.~7?=~J!'..~,t.;;"""'"'"....,''''''''' A, I)" 193,Q.." \ """""""""".."..",..",..,..,""""""""'""""""..,,,,,,..,,,.,""
"~. ......q;lil'1l:.J..~......R;;;;;;;. ...........................................................m...................[j;fP
Filed: ('IOLf.,j,Z..l.9.!f..(J..........,..,........ Attorne,\': ,.."tb,'f\.9..._..,.,.."...."..,......,......,....
, (over)
.,;ll-Rp -y..oS' / /-1.r-.).
..,""""""""',..,""""""""",..,":;z'."'""""",..",..,..,,,",...
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RW-8
INVENTORY OF REAL AND PERSONAL EST ATE
._-
Jln l~r .aUrr IIf l~r fatatr 1Ir.........C.I.,y.....h.:',...,!?~,~:.~........,.......:......,.,....
/J (., 1-1{;1 /Jc":t<!. L"....."I'~
late of .....L!';;.().r.r;.,'J),v.,fi..t.?...~L..,...................in Ihe County of Da,,~hin, State of Penna" deceased,
tJ Jnurntoru of the real and personal estate which were of the above-named
Occ~ . .
......... ."',~'''l-..,....?.;.../:I......................................................,.. deceased, Taken and appraIsed
the ......./V...., day of .E.~rJ.~."',.U!-.y......19 ,f /. (Date of death ...j~,:~.!.J.:..,f:.9....)
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) {' 11 cOo::' 17 !1c.:Cti u.-v-r- -- tn., 11<',.,-/ 5f'''''7 ~ ! tJ t, (. 0/
/ l?cr-cw7':J (' /-f CCk" f-;i Clv11 ()1Cl)/<'I1t'2C 33 ()lJ
/,' ' [),] ONVlH39WnJ
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, ';:;.SID3~
i ,,:i1J">j::OH003H
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Appraised value of Personul Prnperty ,..............................,....,..,....,....,...........,..,.... $ ...of.~,t?..i., I
o
ApprulBed vulue of reul estute .........,.....................,...............................,............... $ ...................
Total appraised value .....................................................,........,..,..,..,................., $ ,.:!...f..~,'i....f$ 7'-
RECAPITULATION
C AFFIDAVIT OF PERSONAL REPRESENT A"fIVE
1.(",,~C"'t..AND
~.~~~~::.:;~~.~..~,..",.,El!.(ii.0.#.,~;.€.~.~.~(,'""',.,.,..",.."."..."",.,."".,.,.".., ...."'.'"",,
~rat Dr the Estate or.......,C::.If.;JI.......,./..,....../?t;;;..-;;..<;;;..............."....",,,...........,..,,.,.."..
deceased. being duly.......:?f.t;...;.<?<I<'..m....I.l,tJP.d,UW"r.,t:..r:::....... according to law, depose and say that the
items appearing iu the Inventury inc!t{de all nf the personal assets wherever situate and a\1 ol the
real estate in the Commonwealth of Pennsylvania of said decedent; that the valuation placed opposite
eal'h item of said Inventory represents its fair value as ol the date ol the decedent's death; and that
decedent owned no r~al estate outside the Commonwealth of Pennsylvania except that which appears
in a memorandum at the end nf the Inventory. \
,..."".."........"...""",,....... and subscribed \ )11uL ~ /-d.
1 I. d 1 "7..~~..;~L?..Z?.2..............."...~......~'''''....
he ore me t 115.................................... ay 0 . 7" Executor.. Administrator
."...".....""...,..,..""........"....... A, D. 19........ ,:i olf uz;;L A /}&.A.;' ,1
..., ~~"..,\..,...".....,...~,,,..,..,',,..';:;:~,,....Iq'.0,.x::;~'7 fA-
......",....."...........""..,..............""........,........... Addr... (/ /
(710 '1
INSTRUCTIONS
1. An Inventory must be filed within three months after appointment of personal representative.
2. A BupplementalluvenlOry must be filod within thirty days of discovery of additional 8Bsets.
a. Additional' sheet8 mny be attached as to personalty or realty.
4. See Article IV. FIduciaries Act or 1949.
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:' ,1~\\fiil.lil'~liii!~,;;i'!;.'i:';;": '., ...", 'cOMMONWEALTHOF PENNSYLVANIA
4,N()1,' " ,.i':,;;',!, ,." DEPARTMENT OF REVENUE " "
. !I1!>,~~p.Q~~~:O'F1e'A' RECEIPT. PENNSVLVAN,A lNHERITANCE AND ESTATE TA'
WI,'..".",,,,;,,,,,,, '",". ',,',
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'\ \ RECEIVED Gla4yt1 M. Ihrenae11er
I I FROM
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ADDRESS 5018 utah Ave.
-
TAX AT 6%
TAX AT 15%
TAXAT_%
ESTATETAX
j
Hal'l'iabuq, pa. 17109
TOTAL TAX CREDIT
lUl9
'--8STATE~FORMAT~N7J~~;-i3---i98()----------
DATE OF DEATH '
21-80-405
FILE NUMBER
COUNTY
GUY L. PICK
cWlbel'lan4
m
m
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_'
, DATE OF PAYMENT
rebxuHy 23, 1981
NAME OF DECEDENT
11.09
------------------------------------------
TOTAL AMOUNT PAID
POSTMARK DATE
EMARKS. .PAID Olll ACCOUNT"
SEAL
RECEIVED BY
.. ;//4ij rl ~.;J
( Ma# C.SI~
Register of willa
I
REGISTER OF WILLS
-----.-
BENEFICIARIES AND ADDRESSES
(State full names and addrosses of all who have an intorost
either vested, contingent or other intorestl
BENEFICIARIES
RELATIONSHIP I SURVIVED I~ OF LIFE
TO DECEDENT DECEDENT TENANTS OR
STATE YES ANNUITANTS
OR NO AT DEATH OF
DECEDENT
INTEREST OF
BENEFICIARY
IN ESTATE
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INFORMATION
PLACE FOR FILING _ The return is to be filed in duplicate with Ihe Register of Wills of the county wherein the decedent resided.
TIME FOR FILING _ The return is due nine months alter the decedent's death. unless an extension for filing has been applied for and granted
by the Secretary of Revenue within the nine-month period.
FAILURE TO FILE RETURN _ Seclion 791 of the 1961 Statute provides that ", , , any person who willfully fails to file a return or
other report required of him, , , shall be personally liable, , , to a penalty of 25% of t:,e tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by law,"
c.-.-_~I
NiASL/l.ND ASSOCIATES, Inc.
MEDIC^L M1TS IJUILDING
220 WI LSQN !.iTA EET
CARLISLE, PA. 17013
r Hr Guy Peck Ec;tote
R.D.I/1, Box 21>1
Gordners, Po 17324
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FOIlWARD
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Thmoct:ntc~!s
TtlOror.t:l1ttl~b t.r.
P!cllr;lllJx.
ConllHchhl1siv., Consult.
HOll,lj C,ll1
Nurslwl I-Iome Visit
f,pln,11 'rap
Emer'lfJrlcy Vl~lt -
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. REV'~B4 P.:X+ (&-801
File Number
Estate Name
Date of Death
Social Security Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLYl
21-80-0405
llJ Originol
o Supplemental
o Remainder
Guy L, Peck
6-13-80
205-09-0642
REPORT OF INHERITANCE TAX APPRAISER
RATE
TOTAl TAX
INTEREST FROM
BALANCE
AMOUNT PAID
S
INTEREST FROM
BALANCE DUE
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I nave appraised the real and p.rsanal property a. reported In the foregoing
retum at the values,.t forth opposlt. each Item In tho last column to the right in Schedules "A", liB", flC", and liE"
AOJUSTMENTS
VALUE AS APPRAISEO CODE (HARRISBURG USE ONLY)
$ none 00+
2 209 84 10+
none 2ll+
none 30+
__2.,20!L- _8
4Q.
A~II(J~/d) -1f'ltAO/f/)
INHERITANCE TAX APPRAISER
REMAINDER APPRAISEMENT CODE
92+
93.
FACTOR
PRINCIPLE
CODE
Dotld:
March 18, 1981
INVENTORY
RIOI P,oporly (Schodulo A)
Perianal Property (Schedule B)
Jolnt,Hold Proporty (Schodulo E)
Transfer. (Schedule C)
TOTAL GROSS ASSETS
Leu D.bt. and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estale
o Annuity
FOR USE OF REGISTER ONL Y
Taxon $
Tax on $
Taxon $
Taxon $
Taxon $
Exempllons
Total Estate
leu Credits
~ATE OF PAYMENT
VALUE
CODE
COMPUTATION OF TAX
S
S
S
$
$
6%
15%
TO
$
$
$
DISCOUNT
INTEREST
TAX CREDIT
+ $
S
=
$
+
=
BALANCE
TO
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